1. Longitudinal Coordination of Care (LCC) Workgroup (WG) HL7 Tiger Team Patient Care WG Care Plan DAM July 31, 2013 1

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded o Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. o Send comments to All Participants so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Participants

3. Agenda Goals Schedule Review of recommendations made to PCWG for Care Plan DAM –Items implemented in time for ballot –Items not implemented in time for ballot –Items not included in the DAM Next Steps 3

4. 4 For this Tiger Team: Alignment of HL7 artifacts with LCC artifacts to support care plan exchange HL7 CCS provides Service Oriented Architecture Care Plan DAM provides informational structure LCC Implementation Guides provide functional requirements Ongoing comments can be submitted and viewed on wiki: http://wiki.siframework.org/LCC+HL7+Tiger+Team+SWG Goals

5. Work Group Schedules LCC WG SWG MeetingLCC LeadsDate/ TimeProjects LTPAC SWGLarry Garber Terry O'Malley Weekly Mondays, 11-12pm EST C-CDA: Transfer Summary, Consult Note, Referral Note LCC HL7 Tiger Team Russ LeftwichWeekly Wednesdays, 11- 12pm EST LCC WG comments for HL7 Care Plan DAM LCP SWGBill Russell Sue Mitchell Jennie Harvell Weekly Mondays and Thursdays 5-6pm EST C-CDA: Care Plan, HomeHealth Plan of Care HL7 WG SWG MeetingHL7 LeadParticipating LCC Members Date/ TimeProjects HL7 Patient Care WGRuss Leftwich Elaine Ayers Stephen Chu Michael Tan Kevin Coonan Susan Campbell Laura H Langford Lindsey Hoggle Bi-weekly Weds, 5 - 6pm EST Care Plan DAM Care Coordination Services (CSS) HL7 Structured Documents WG Bob Dolin Brett Marquard Sue Mitchell Jennie Harvell Weekly Thursdays, 10-12pm EST CDA (various) HL7 SOA WG CCS ProjectJon Farmer Enrique Meneses (facilitators) Stephen Chu Susan CampbellWeekly Tuesdays 5 - 6pm EST Care Coordination Services (CSS) HL7 Patient Generated Document Leslie Kelly HallWeekly Fridays, 12- 1pm EST Patient-authored Clinical Documents

6. Schedule – July 2013 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 123456 11 AM ET Discussion Plan Activity Data Element Attributes 78910111213 11 AM ET Discussion Team Member Relationship to Patient 14151617181920 1:30 PM ET Continued Discussion Team Member Relationship to Patient 21222324252627 11 AM ET Meeting Cancelled 28293031 11 AM ET Review of DAM Recommendations

7. Overview Recommendations were formulated as a result of discussions involving the following subjects: –Patient and Provider Roles in Plans of Care and Care Plan –Preferences –Priorities –Levels of Association –Team Member Acceptance/Acknowledgment –Care Team Member Role –Care Team Member Cardinality –Team Member Responsibility – Care Plan 7

8. 8 Patient and Provider Roles in Plan of Care and Care Plan Discussion: What role does the Provider play and what role does the Patient play in both the Care Plan and the Plan of Care? Recommend that DAM should support both the Care Plan and Plan of Care, sequential and multi-threaded workflows; needs to define the buckets of all the information for all of these. Recommend adding attribute to Goals that can indicate that the goals have been agreed to by both the Provider and the Patient or that there is not agreement between the two. Recommend adding another attribute that supports specific health concern and intervention related goals (who has agreed to these goals).

9. 9 Patient and Provider Roles in Plan of Care and Care Plan, cont’d… Recommend allowing for variance analysis with levels of intervention. Recommend adding/supporting an ability to harmonize multiple treatments and Plans of Care and to create a Master Care Plan in the care of complex Patients in complex organizations.

10. 10 Preferences Discussion: How to represent preferences in DAM; how to show changes have occurred in a patient’s preferences Recommend adding a separate Advance Directives section that contains all preference information including advance directive preferences, which are linked to a repository or separate document. Recommend listing out and defining “Other preferences” under Types of Preferences.

11. 11 Priority Discussion: What data elements should have priority attributes and whether interventions should be prioritized, as well. Recommend not including Priority in interventions. Actions that were considered and not chosen as part of the intervention should be included elsewhere in the Care Plan. Recommend adding a text field with Priority so that comments can be captured with priority rankings.

12. 12 Levels of Association Discussion: Is it sufficient to associate one or more Care Team Members with a data element or should the model include levels of association? If so, what is the value set for those role/relationship levels? How many levels should there be and how are they represented (e.g. primary/secondary,/tertiary, or lead/support, or other) Recommend including associations in model for traceability (assignment of responsibility, payment, etc.): provide a bucket for association/responsibility level, bucket for functional role, and bucket for identification of responsible/associated individual or entity Recommend that High, Medium, Low be used as association/responsibility level designators for both Health Concerns and Interventions.

13. 13 Levels of Association, cont’d… Recommend that association should include individual and organization under functional role (Care Team Members may have more than one role inside an organization) Recommend that Health Concerns and Interventions also include type of association (e.g., fee for service, consent, other)

14. 14 Discussion: Does the Care Team Member need to accept/acknowledge their association? Recommend including the ability in the model for a Care Team Member to accept/acknowledge their association Team Member Acceptance/Acknowledgment

15. 15 Care Team Member Role Discussion: Current model includes “Role” attribute in Health Concern but not in Health Goal or Plan Activity. Recommend establishing a taxonomy to support how the association/relationship will be used (e.g., as a messaging filter to only send information to certain entities and/or showing who is involved and their sub- roles and/or other).

16. 16 Discussion: Can Health Concerns, Goals and Interventions be associated with zero care team members within the DAM (other than the patient, who would be associated by default)? Health Concerns to Team Member Recommend Health Concern can be zero to many cardinality, with SHOULD conformance Goals to Team Member Recommend Goal can be zero to many cardinality, with SHOULD conformance Interventions to Team Member Recommend Intervention (Plan Activity) can be zero to many cardinality with SHOULD conformance Team Member Cardinality

17. 17 Discussion: Is Team Member’s responsibility for the Care Plan represented in the model? Care Planning Care Plan Governance Recommend a way to account for facilitation of the Care Plan (“steward” role or other) Team Member Responsibility – Care Plan

18. Proposed Next Steps Next meeting is TBD and will be a full review of the final Domain Analysis Model

19. 19 Contact Information We’re here to help. Please contact us if you have questions, comments, or would like to join other projects. S&I Initiative Coordinator Evelyn Gallego evelyn.gallego@siframework.orgevelyn.gallego@siframework.org Sub Work Group Lead Russ Leftwich cmiotn@gmail.comcmiotn@gmail.com Program Management Lynette Elliott lynette.elliott@esacinc.comlynette.elliott@esacinc.com Becky Angeles becky.angeles@esacinc.combecky.angeles@esacinc.com